Hippotherapy and Exercise in Multiple Sclerosis: Effects on Gait, Fatigue, and Quality of Life

This study examined the effects of a combined hippotherapy and ground exercise program on gait performance, fatigue, energy expenditure, and quality of life (QoL) in individuals with multiple sclerosis (MS), with a focus on both immediate and sustained outcomes. Twenty participants with MS were divided into an intervention group (IG; n = 11) and a control group (CG; n = 9). The IG underwent a two-month program comprising 13–16 sessions of hippotherapy and ground exercises. Assessments were conducted at baseline, post-intervention, and six weeks later (follow-up). Outcomes included the Modified 6-Minute Walk Test, Physiological Cost Index (PCI), Fatigue Severity Scale (FSS), Visual Analogue Scale for Fatigue (VAS-F), and the MSQoL-54 questionnaire. The IG showed a significant improvement in walking distance (p < .001), without a concomitant increase in state fatigue (VAS-F), which was maintained at follow-up. Trait fatigue significantly decreased (FSS score reduction of 11.36 points, p = .014). PCI remained unchanged. QoL improved significantly in both physical and mental domains (p < .01). No significant changes were observed in the CG. Satisfaction with sexual life did not change in either group. In conclusion, a combined hippotherapy and ground exercise intervention improved walking performance, reduced trait fatigue, and enhanced QoL in people with MS. These benefits were sustained post-intervention, suggesting that such programs can be an effective and lasting non-pharmacological strategy in MS rehabilitation.